Category Archives: health

Making a vaccine in record time

Did you ever wonder how Covid-19 vaccines were developed so quickly? Usually it takes five or ten years to develop and approve a new vaccine, but in 2020 several vaccines were ready in less than a year. This speed led to suspicions about quality and safety being compromised.


Sarah Gilbert

     For an explanation, turn to the new book Vaxxers by Sarah Gilbert and Catherine Green. They are key members of the team at Oxford University that developed the AstraZeneca vaccine. Vaxxers is an engaging first-hand account that contains many insights.

Gilbert and Green had been working on vaccine development for a great many years. They and their collaborators sought ways to prevent diseases such as Ebola, malaria and MERS. One of their accomplishments was development of a vaccine platform, a cell structure that could be used to enable new vaccines to be created very quickly.

People sometimes say, “Why wasn’t anyone preparing for a new pandemic?” Gilbert and Green say, with some exasperation, that is exactly what they were doing. The trouble was that they found it exceedingly difficult to obtain funds to make better preparations.


Catherine Green

Nonetheless, when Covid arrived on the scene, they were far better prepared than they might have been. The initial challenge was to recognise that the first reports of a new infectious disease in Wuhan, China, represented an urgent priority. Gilbert and Green had other projects under way, and a variety of personal and professional commitments. They started monitoring the reports of the new disease. It took some time before they decided to act. When they did, progress was rapid. As soon as they obtained the genetic structure of the new coronavirus, later named SARS-CoV-2, they used their platform to create a vaccine.

“This meant that before we even knew the pathogen’s genome, we knew the design for our vaccine — the gene coding for the SARS-CoV-2 spike protein, plugged into ChAdOx1 — and once we did receive the genome, we were able to design the exact DNA sequence we needed within forty-eight hours. Less than four months after that we had the first doses made, quality-assured, and ready to use in clinical trials.” (pp. 153–154)

They make it sound easy!

As it became clear that the new disease, called Covid-19, would require full attention, they gradually mothballed their other projects and put their full energy on developing and testing a vaccine for Covid. Having a small quantity of a vaccine was just the beginning.

A personal story

Each of the chapters of Vaxxed is told either by Gilbert or Green, giving a personal perspective labelled as Sarah or Cath. The result is in part a sort of scientific autobiography. They each tell of their personal lives, their families and difficulties, their eating habits and especially their anxieties about producing the vaccine.

They put themselves under immense pressure to do everything required to make a high-quality vaccine in record time, knowing that every day shaved from the usual development schedule could make the difference to people’s lives and also knowing that mistakes could make the whole process come unstuck. At crucial stages, such as purifying the vaccine and unblinding trial results, they were confident due to having been through the same stages with previous vaccines, but they were also on tenterhooks because so much hinged on the outcome.

Scientists spend much of their time in labs and with their colleagues, and non-scientists can have a hard time appreciating what goes on. In Vaxxed, we are offered an inside look into everyday science, though in this case undertaken at high intensity and with high stakes. Gilbert and Green show they are humans just like the rest of us, with cares, hopes, distractions and lives outside of science, and with great experience and dedication in their research roles.

It is amazing that such a story has been told so soon after the events, indeed told at all. Scientists working for governments or pharmaceutical companies would have a hard time gaining approval to write such a revealing memoir. For scientists used to writing technical papers for journals in their fields, adopting a style aimed at a general audience is no mean feat. That Vaxxed is so readable may be attributed in part to excellent editorial support. At the bottom of the title page, in small print under Gilbert and Green’s names, is “Written with Deborah Crewe.”

The Oxford lab was set up to develop vaccines, not for mass production. At a crucial time, the pharmaceutical company AstraZeneca was brought on board to collaborate with the Oxford scientists and produce the vaccine in commercial quantities. Rather than using laborious lab methods to produce dozens of doses, AZ could scale up production to millions or even billions of doses.

Unlike other companies producing Covid vaccines, AZ made the magnanimous decision to provide its vaccine at cost, namely with no profit, for the duration of the pandemic, and indefinitely for low and middle-income countries. It is far cheaper than the Pfizer or Moderna vaccines.

The media

Few scientists have a high media profile, nor do many seek media attention. University administrators now encourage scientists to showcase their research, providing support from professional units that help write media releases. Gilbert and Green had been working for many years with this sort of limited interaction with journalists. Vaccines for diseases in foreign countries are seldom newsworthy. With the pandemic, suddenly there was intense interest in vaccine development for a disease affecting people in their daily lives.

Gilbert and Green tell about their steep learning curve doing media interviews, for example learning that an off-the-cuff comment, taken out of context, could become a misleading headline. They were pleased that so much coverage was supportive but then upset when a routine occurrence — pausing the trial while an adverse event was investigated — was misinterpreted and blown out of proportion. Before long, they referred all enquiries to the university’s media unit, as it was impossible to handle all requests and to do so would have meant slowing their work on the vaccine.

Gilbert and Green sometimes had to push back against media intrusions, especially when film crews in the lab caused work to be compromised. On the other hand, they appreciated the opportunity, provided by the media, to publicise the vaccine and, more generally, to enable them to get out messages they thought were important.

Lab life under a media microscope

Quite separately from its contribution to understanding vaccine development, Vaxxers is a valuable contribution to writing by scientists about their own work. The classic book in this genre is James Watson’s book The Double Helix, his account of unravelling the structure of DNA, an account criticised for male chauvinism, in particular downgrading the role of Rosalind Franklin. Vaxxers, in contrast, is written by two women scientists who explicitly deny being pathbreakers or heroes. They repeatedly acknowledge the others in their team and explain how their work on the vaccine built on years of prior work and experience. They worked extraordinarily hard not so they would be recognised as elite scientists but because they wanted to do what they could to save lives.

“Before 2020, no one had ever developed a vaccine in a year. But that was not because it could not be done. It was because it had never been tried. We were able to go faster in 2020 not because we cut any corners or took risks with our product. We still did every single thing that needed to be done to develop a vaccine safely. We did not miss out any steps. Nor was any individual task — filling a vial, vaccinating a volunteer, analysing a graph — done with less than the usual care and attention. We went faster because we had to this time — the world needed the vaccine as soon as possible and, as we know from seeing the daily death rates, every day counts.” (pp. 160–161)

Vaxxers is also different from most books in the first-person scientist memoir genre in consciously being an intervention into the debates surrounding the research. Gilbert and Green are acutely aware of concerns about the safety of Covid vaccines developed at such great speed and want to explain how they were able to move so quickly without compromising quality or safety. In this they have undoubtedly succeeded. What they cannot do, of course, is to provide the same sort of reassurance about other Covid vaccines. We can read Vaxxers but no equivalent story written by government or pharmaceutical company insiders is ever likely to be published.

While Vaxxers addresses some of the concerns about Covid vaccines, it cannot deal with all of them. The full story of the health effects of the vaccine remains to be told, as does the comparison between risks from vaccines and Covid itself, for different demographics. Nor is the story over, because new variants of Covid continue to appear, meaning that new versions of vaccines may be developed.

The only time Gilbert and Green’s treatment loses authenticity is when they write about vaccine hesitancy, about which they rely more on others’ treatments than their own research and experience. For example, Gilbert writes, “I don’t understand anti-vaxxers” (p. 192). This is understandable given that she’s not a social scientist who has spent years interviewing parents and trying to learn about vaccine hesitancy.

Regarding blood clots from the vaccine, Gilbert makes a comparison with the risk of blood clots from having Covid or from taking the contraceptive pill. This is reasonable on the surface, but Gilbert is not an expert on the science and politics of risk assessment, about which there is a vast body of research addressing complexities and value judgements.

Final comments

Supporters of vaccines can learn from Vaxxers about how the substance injected into their arms was developed. Critics of vaccines can learn this too. All their criticisms will not be answered, but at least they can be better informed.

Gilbert and Green worked exceedingly hard and long for many months, and desperately needed a break. They write about what they will do after Covid priorities recede. It’s good they decided to take the time to write Vaxxers.


Sarah Gilbert with the Barbie doll modelled on her

Brian Martin
bmartin@uow.edu.au

Disclosure: I had the AstraZeneca vaccine — hence my special interest in Vaxxers — and had no side effects.

Comments from Robyn Gardner

Your review of Gilbert and Green’s work seems very balanced to me. My only reservation concerns the rush to autobiographical disclosure by scientists, which seems so common now in all fields, in government, media and the military. The speed of publication indicates that at some point it becomes part of the potential framework of research or design in any career-sensitive lab. The ‘confession’ is a kind of promotional agency, akin in some ways to pharmaceuticals’ harnessing of patient groups/parents/human interest stories for their own profits. The result is an erosion of the integrity we may imagine of/in science, pre-empting and incorporating the earlier systems of external critique and history of science.

It seems to me that popularizing and personalizing of research via the highly marketable and more inclusive representation of women is as risky in its way as the effacing of women  earlier was, which was, let’s face it, probably no different or inexorable as the effacing of many, many men – there being more men, in earlier periods, so that women may actually have had more ease of access, if only by dint of a family connection or their exception.

We still await some highly nuanced outside assessments of this cultural history and the very problematic politics of vaccine production, something akin to David Oshinsky’s Polio: An American Story which examines  the wider cultural context of a pandemic. Oshinsky’s book addresses the ‘boosters’ and marketeers of that first wave of public image harnessing as well as the personal volatile histories of Salk and Sabin. Furthermore, it addresses the upscaling of vaccine production by the moves from research and laboratory science to outsourced not-for-profit production (by the same agencies as for-profit ones or harnessed with them)  through the process of ‘gifting’ to middle tier as well as third world countries. Then there’s the old story of poorer places being used for testing in an era when you can’t as easily inject into the bodies of the disabled or the ‘isolated’ cultures of poor countries – unless you redefine them loudly and publicly as ‘most vulnerable’ and needing to be ‘included’.

We rapidly approach the place in which we are all included – so where precisely is the control group, of the unvaccinated? And what, historically, does this serve to cover over, if we’ve all been injected with so many and variable (including simian viral) and DNA active or lipid adjuvant substances, and what levels of biosecurity can possibly pertain given the places and speed of outsourcing in manufacture?


Robyn Gardner

I think of the silencing, and self-silencing, of any possible response, and of the wholesale ‘turn away’ from the polio vaccine origin-of-AIDS thesis by even those scientists who found it highly plausible, and on the part of  those who  could have been and should have been most active in inquiry. 

My concern about AstraZeneca is not the reporting of side effects in the short term, but the widely mediated hijacking of this possibility by labs and agencies and ghost-written preprints focussing on the ‘rare’ clotting events of the disease itself. The possibility of long term and highly likely slower vascular changes, not reversible, but activated – a ‘forever’ event – in vaccinated subjects will tend to get deluged and overwritten, buried, by the usual facile response of Covid causing the same or greater risk. So it goes. I guess this is science and business as usual, and the post-war scepticism about biological research, and rise of ethics, is now in reversal. We are all in thrall again to something called ‘the science’ – which is seen as pure again, and all inclusive, whilst any postgraduate qualification in the human sciences, which might include historical awareness and critical thinking, if not always clear, will cost a leg and an arm.

On not making up your mind

I’m finding it extremely difficult to remain open to a range of possibilities. On Covid in particular.

            I’ve read a large number of articles about Covid and talked with lots of people. There are articles about the urgent need for vaccinations and others about the risks of adverse reactions. There are articles about lockdowns and wearing masks, with different viewpoints. There are articles about the origin of Covid, some saying it came from wet markets and others saying it was from a lab leak.

When I read a well-documented and well-argued analysis, I think, “That’s persuasive.” Then I read another from a different perspective and think, “That sounds persuasive too.”

            Some time after the beginning of the pandemic, I decided to try to remain open to different views rather than reaching a firm conclusion. For example, there are claims for and against using ivermectin as a prophylactic, to reduce the risk of getting Covid. I don’t want to decide definitively one way or the other, at least not yet.

The trouble with reaching a firm conclusion is being trapped by confirmation bias. If I decide that mask rules are right or wrong, then I am likely to pay attention to material that supports my belief and to dismiss contrary information. I might find myself in an echo chamber.

This doesn’t mean I can’t make decisions. As soon as the AstraZeneca vaccine became available, I had my shots. That was a personal choice. But since then I’ve tried to remain open to information about the hazards of vaccines, for example from a rare blood clotting condition. Maybe it’s more common than official figures indicate.

            You see, I’m a social scientist, and I’ve studied numerous public scientific controversies, including ones over nuclear power, pesticides, fluoridation and the origin of AIDS. On some of these issues I have a strong personal view but on others I don’t. For social analysis, it sometimes can be helpful not to care strongly about the topic under investigation, as this enables looking at the dynamics of the controversy from a less emotional perspective.

A decade ago, I started studying the vaccination debate. For me, vaccination was not a personal issue, having no children and no particular problem with vaccines; I’ve had the flu vaccine for the past five years. My angle was to support free speech for vaccine critics, because I believe free and open discussion of contentious issues is better than trying to silence contrary views.

            Being open to different perspectives on vaccination was like a warm-up for being open to different Covid viewpoints. Dominant perspectives are presented by the World Health Organisation and the Centers for Disease Control and Prevention as well as by various governments and health authorities. The mainstream media mostly report the views of authorities. But then there are contrary views, some of them supported by a few doctors and researchers, readily available on social media. By subscribing to newsfeeds giving different perspectives, the volume of commentary soon becomes overwhelming. Even to try to understand the subtleties of a single issue, for example hydroxychloroquine, becomes a bottomless pit of claim and counter-claim.

Sometimes official recommendations change, for example on mask-wearing. That should encourage remaining open to different views, because you never know when a dissident view might suddenly become the orthodoxy. What I’ve learned through my studies of scientific controversies, though, is that many people, especially campaigners, adopt a view and stick with it regardless of new evidence.

            A neighbour told me that her young daughter was in hospital with a mysterious illness. It developed shortly after a routine childhood vaccination, but her doctors were adamant that the illness was not connected with vaccines. My neighbour wasn’t sure. I thought, how can the doctors be so sure? Why couldn’t they be open to the possibility, however slim, of an adverse reaction? Thankfully, her daughter recovered.

I’ve talked with colleagues who are passionately pro-vaccination and condemn anyone who is hesitant as misinformed or worse. These colleagues do not work in any field related to health, so I think, “How can they be so sure?” Are they confident because their view is the same as that of health authorities?

I’ve also talked with passionate critics of vaccination orthodoxy. Some of them have studied the issues extensively but others less so. How can they be so sure? Doesn’t anyone have doubts about what they believe?

            Trying to keep an open mind has been challenging, especially when talking with others who have strong views and think anyone who disagrees is foolish or even dangerous. It seems everyone has an opinion, even those who know little about the issues. Am I being foolish by trying to remain open to different ideas?

Some views seem so extreme or peculiar that I tend to dismiss them out of hand. Some of the claims in the “Plandemic” videos seem implausible to me. But I haven’t studied the topic in depth, so should I be confident about my judgement? Perhaps I can just ignore Plandemic claims, assigning them a tiny probability, at least until more people start taking them seriously.

            Ah, here’s a clue. When others take an idea seriously, it’s tempting to go along with them. This is influence via what is called social proof. Anyone trying to be a rigorous thinker presumably should be alert to this influence and attempt to counter it, or at least to examine the evidence used to support the idea. But this leads back to the beginning. It’s impossible to investigate all the evidence on all facets of Covid, or indeed any other controversial topic.

As I’ve persisted in trying to remain open about Covid issues, while still making decisions, I’ve noticed something else. On other issues, especially ones I haven’t studied in depth, I’m more likely to question my views. Will this lead to a state of precarious uncertainty? Or will it be a refreshing and invigorating alternative to the usual rush to judgement?

For helpful suggestions and thoughtful comments, thanks to Tonya Agostini, Paula Arvela, Kathy Flynn, Suzzanne Gray, Julia LeMonde, Monica O’Dwyer, Dalilah Shemia-Goeke, Jody Watts and Qinqing Xu.

Brian Martin
bmartin@uow.edu.au

Why you should get moving

Physical activity is good for you in lots of ways, so why do so many people not get enough?

The evidence is overwhelming: exercise is good for you. Not just physically, but also mentally. Exercise reduces depression and anxiety. It boosts your memory. It protects against disease.

I’ve just read a new book, Move! by Caroline Williams, that tells about some of the latest research on the benefits of physical activity. More on that in a moment. First, a few observations.

Working in universities for many decades, I’ve met numerous smart people, including some who think highly of their own intellects. After all, one of the few talents that academics have more than others is using their minds to extend knowledge. Yet if academics are proud of their mental capacities, and seek advancement in their careers depending on the outputs from their intellectual prowess, why do so few take heed of the evidence that physical activity protects the mind and boosts mental performance?

            There are several possible explanations. One is a persistent belief that the mind is pretty much independent of the body. Another is that using your body is lower in status than mental work. This is why, if you’re going to exercise vigorously, do it in a gym where you have to pay, not out in public. Driving a car is more dignified than walking to work.

A third explanation is that our lifestyles are designed to discourage exercise. More on that later.

Move!

Caroline Williams is a science writer. She interviewed scientists researching how the body affects the mind, and weaves what she has learned into an engaging account, adding comments drawing on her own experiences. If you need convincing that movement is good for you, Move! is a good place to start.

            The book is more than a motivator. Williams tells how different sorts of movement affect different aspects of mental performance, including creativity. She starts by telling about human evolution and how movement and mental functioning are intertwined.

“… our biological baseline is to be on our feet, moving and thinking at the same time. If we don’t do it, our brains make the sensible decision to save energy by cutting brain capacity. In better news, when we get on our feet and move, it primes the brain to be alert and to learn.” (p. 32)

This reminds me of research I read about years ago saying that the brains of people over age 50 start to shrink — except for those who exercise regularly. Use your body or lose your mind.

Williams reports on research about physical activity and rumination, which is repeatedly and unproductively thinking about things in the past. The more you ruminate, the less happy you’ll be. Here’s a surprising finding. When you are moving, walking or jogging, you are literally putting things behind you, and this sense of forward movement reduces rumination and hence is good for your mental health. This made me wonder whether walking outdoors is superior to walking on a treadmill, because with a treadmill you remain in the same place. Maybe you still feel you’re moving forward, especially if you watch a screen showing scenery going by.

            As well as moving, it’s also valuable to build your strength. Having stronger muscles leads to a longer life and makes you feel better too. You don’t need a physique like Arnold Schwartzenegger’s: you can be stronger without any increase in muscle size. There are mental benefits too. Williams states:

“There is also a link between bodily strength and a healthy brain. A ten-year study of twins showed that greater strength in middle age is linked not only to more grey matter but also to a better functioning memory and a quicker brain a decade later, while grip strength (an overall indicator of muscle power) is associated with a healthier hippocampus.” (p. 57)

Many people think muscle-builders are less intelligent than weedy types who spend their days reading. This needs to change. Having strong muscles and flexing them regularly is a good way to enhance brain power and creativity.

To get moving is good. To do it in rhythm is even better, certainly for mental functioning. Dancing is one option. Another is an exercise class, accompanied by energising music.

            Moving together with others dissolves the sense of self, so you feel part of the group. Williams notes that you need to be careful about this. The Nazi salute and mass rallies helped to bond the German population with Hitler.

“Sit up straight!” Did your parents ever tell you this? Slouching may feel more comfortable, but there’s solid scientific evidence about the physical and mental benefits of good posture. Sitting or standing straight is linked to having positive thoughts. More generally, using core muscles is good for controlling stress. Options include running, Pilates and yoga. Strangely, using core muscles is calming.

            Stretching is good for you too. If you’ve been sitting for a while, it’s beneficial to get up and stretch. Williams delves into the advantages and disadvantages of stretching beyond what the mind says is too far, and the challenges for those who have hyper-mobile joints.

Then there is breathing, normally an automatic activity but one that can be the focus of attention. Williams tells of research on breathing six times per minute, a process that stimulates the vagus nerve and calms the body.

Barriers to physical activity

Given decades of research showing the physical and mental benefits of physical activity, you might think that everyone would be going out of their way to keep active. Alas, only a minority do, and those who are older and need it the most are the least likely to move enough for optimal mental and physical health. Why?

The main problem is that humans have constructed environments for themselves that make it too easy to be lethargic, at all ages. Think of “labour-saving” devices. Think of cars, ride-on mowers, video games, Facebook. Think of parents protecting their children by driving them to school.

In the book The Energy Glut, Ian Roberts says cycling to work is dangerous but it’s even more dangerous not to cycle to work. In other words, the health risks from not getting exercise are greater than those from commuting by bicycle.

            In Australia and many other countries, cities are constructed in ways that discourage everyday walking and cycling. There are vast car parks around shopping centres and just a few places for bicycles. Imagine an alternative urban design, closer to that in Amsterdam, that makes it easy and attractive to walk and cycle, and makes it slow and inconvenient for drivers.

Unfortunately, most of us live in what is called an obesogenic environment, one that discourages activity and encourages overeating. Although it’s possible to go to the gym or participate in sports, the trouble is that this requires initiative. A society that prioritises movement would design the physical environment and incentives so that being active would be the easy option and sitting for hours on end was considered foolish.

We can dream about an alternative society, but until things change it is mostly up to individuals to do what they can in their personal situations. So read Move! and be inspired. And while you’re reading it, remember to occasionally get up and stretch.


Caroline Williams

PS Some earlier accounts that I’ve found useful.

John Ratey with Eric Hagerman, Spark: The Revolutionary New Science of Exercise and the Brain (New York: Little, Brown, 2008)

Ralph S. Paffenbarger, Jr. and Eric Olsen, LifeFit: An Effective Exercise Program for Optimal Health and a Longer Life (Champaign, IL: Human Kinetics, 1996)

Roy J. Shephard, Aging, Physical Activity, and Health (Champaign, IL: Human Kinetics, 1997)

Thanks to Tonya Agostini, Julia LeMonde, Monica O’Dwyer, Tim Johnson-Newell and Jody Watts for helpful comments.

Brian Martin
bmartin@uow.edu.au

The virus and the economy

The coronavirus pandemic highlights fundamental shortcomings in the way the economic system is set up.

What is the best way to respond to covid-19? There is commonly assumed to be a trade-off between lives and the economy: precautions and controls are needed to save lives but they cause damage to the economy.

There’s an unstated assumption in this thinking, namely that “the economy” is vital to people’s wellbeing. This needs to be questioned. It has been long known that the Gross Domestic Product or GDP is not an accurate reflection of people’s wellbeing. GDP is boosted by negatives such as traffic accidents, environmental destruction and ill health.

A deeper problem is that people’s happiness levels are not very sensitive to increases in average income, at least above some basic level. Happiness depends more strongly on things like close personal relationships, having a purpose in life, physical activity, expressing gratitude and helping others. In countries with a high GDP per capita, average happiness levels have been mostly stable for decades despite continuing economic growth.

            Another problem is inequality. GDP per capita might be high but hide inequality: the average income might be rising but mainly to benefit the top 10% or top 1%. The more unequal the distribution of income and wealth in a country, the worse off it is in lots of ways, such as more illness, crime and mental disorders.

The economic system

Pandemic control measures have highlighted the problem of thinking of the economy as a universally beneficial entity that needs to be protected and enhanced. The economic system is better understood as a particular way of organising two things: production and distribution.

First think of the production of goods and services, which involves people, skills and technology. Food production, for example, involves growing and harvesting crops and getting them to consumers. We see the results of production around us all the time: streets, hairdressers, schools and mobile devices.


Do you deserve to own a luxury villa?

The second part of the system is distribution, which refers to who gets what. Some people have palatial homes; others are homeless. Some people have access to expensive entertainment; others do not. The assumption underlying the distribution system is that it is based on merit in some way, so those who contribute the most receive the most. This assumption is deeply flawed.

Suppose you were born with a serious brain impairment and your parents abandon you. It will be pretty difficult for you to learn to read and write, much less obtain a high-level job. Do you deserve less than someone born unimpaired into a wealthy family?


Do you deserve to be homeless?

            You may feel that you’ve worked very hard in your life, so you deserve a good salary. But what about someone who worked just as hard but had a bit of bad luck and ended up in an also-ran category? The difference between a sports star and one who didn’t make the grade may be a matter of a few seconds in a race or being injury-free or getting a lucky break. The difference between a CEO and lower-level manager may be only a matter of who you know or of having just the right style and conformity to rise in the organisational hierarchy. The role of luck in success is often neglected.

The way the economic system distributes goods and services to people depends on a whole range of arbitrary arrangements, including laws on inheritance, occupational barriers, and the sorts of employment that receive compensation. Being a parent is usually unpaid, yet it is vital to the operation of the system.

The coronavirus pandemic has highlighted the arbitrariness of the distribution system. Entire industries, such as tourism and hospitality, have been devastated. The idea that workers get what they deserve is shown up as misguided. It was misguided before, but now this is more obvious.

Universal basic income?

What is the alternative? One option is a guaranteed annual income, also known as a universal basic income or UBI. Everyone, from newborns to the elderly, would receive a regular income, no strings attached. Anything earned would be in addition.

            Many people respond to the idea of a UBI with a series of objections. How will it be paid for? Who will do the undesirable jobs? Won’t lots of people just decide not to work? There’s a body of research and writing addressing such objections. The calculations about how to pay for a UBI have been carried out. If no one wants to do undesirable jobs, then increase wages. There have been experiments showing that when poor people are given cash, nearly all use it “responsibly.”

The objection that people can’t be trusted to use money responsibly is always used against the poor, not the rich. If people can’t be trusted receiving money they didn’t work for, then inheritance should be abolished. After all, someone inheriting a lot of money can’t be trusted to use it responsibly.

The other side of the UBI issue is its benefits. Millions of workers would be liberated — if they so wished — from what David Graeber calls “bullshit jobs.” These are jobs that benefit no one and could be gotten rid of with no loss of productivity.

            Decades ago, J. W. Smith wrote The World’s Wasted Wealth, documenting the massive amount of production in excess of needs in industrial and post-industrial societies. Smith showed that a large percentage of work in many occupations serves only to redistribute wealth to those occupations, with case studies of insurance, law, transport, agriculture, medicine and welfare. Smith also argued that property rights, by being too great, take wealth from the community, with case studies of land, finance capital, intellectual property and communications. His overall conclusion is that organisation of society is highly wasteful and destructive, all to ensure that privileged groups retain their privilege.

            Work is a vital part of many people’s lives. It gives meaning, provides a connection to others and, bullshit jobs aside, provides some satisfaction for contributing to society. There’s evidence that people gladly accept lower pay if their work helps those with the greatest need. Indeed, research shows that helping other people is a powerful way of increasing happiness.

A UBI would also address the curse of the contemporary economy, job insecurity. In the economic approach called neoliberalism, workers are treated as free agents who have to sell themselves to employers, without guarantees of security. This is supposed to boost “the economy” but sacrifices the wellbeing of a large number of the people who are supposed to be served by the economy.

Job insecurity contributes to the spread of the coronavirus when people who have disease symptoms feel they must show up for their jobs to survive. A UBI would reduce the incentive to work while ill and thus save lives.

Industrial and post-industrial societies have an enormous productive capacity, far greater than necessary to provide necessities to every individual and to provide extra support for those who need it the most. Yet these societies are stuck in economic arrangements that assume scarcity, protect and reward the wealthy and stigmatise the poor and marginalised. Logically, it would make much more sense to celebrate abundance and spread it around. In part, this can be done by expanding the commons, those resources that are available to all. In part, it can be done by designing work around the needs of people rather than fitting people into slots in “the economy.”

What level for society?

In their pioneering book The Spirit Level, Richard Wilkinson and Kate Pickett gathered a range of evidence about the links between economic inequality and the quality of life. They found a remarkable consistency in these links: in just about every way, inequality was associated with bad outcomes for people. When societies are more unequal in income and wealth, they are likely to have more crime, shorter life spans, higher prison populations, more mental illness, worse health and poorer educational performance.

           It is important to note that inequality is not the sole causative factor. For example, a range of socio-cultural factors can affect people’s wellbeing.

A decade later, Wilkinson and Pickett wrote another book, The Inner Level, in which they canvass a wide range of research on the ways that inequality affects people’s behaviour and thinking. Inequality, they argue, makes people more status-sensitive, fosters materialism and makes relationships more difficult. Wilkinson and Pickett write,

“The reality is that inequality causes real suffering, regardless of how we choose to label such distress. Greater inequality heightens social threat and status anxiety, evoking feelings of shame which feed into our instincts for withdrawal, submission and subordination: when the social pyramid gets higher and steeper and status insecurity increases, there are widespread psychological costs. Status competition and anxiety increase, people become less friendly, less altruistic and more likely to put others down.” (p. 56).

Wilkinson and Pickett say that inequality leads to pressure to present yourself to others in a flattering light. It leads to more narcissism, more business psychopaths, less empathy and altruism. Yet there is some hope. Studies show that when rich people think about egalitarian values, they become more ethical. Wilkinson and Pickett cite surveys showing most people would prefer their societies to be more equal economically.

Research on inequality suggests that everyone, including the rich, would be better off if societies were more equal, yet the driving forces pushing for ever greater economic inequality seem relentless, at least since the rise of neoliberalism in the 1980s. How to help counter these forces is a great unanswered question. Suffice it to say that groups are doing what they can to raise awareness, promote alternatives and encourage action.

            In this context, the pandemic is a wildcard. It offers an incentive for communities to pull together and make sacrifices to protect those who are most vulnerable. It sends a message that there is more to life than money and status. Indeed, life itself is at stake. Furthermore, pandemic control measures, by requiring greater distancing between people, have highlighted the importance of personal relationships in wellbeing. By forcing some people to slow down, the control measures have the potential to encourage people to reflect on their lives and priorities.

On the other hand, pandemic control measures are having some disastrous effects, increasing the risk of domestic violence and suicide, while enabling governments to justify draconian powers for surveillance and control of movement. It is possible to lapse into despair at the prospect of a terrible choice between control measures of indefinite duration and a continuing health crisis. A more positive agenda comes from looking at the way the pandemic opens the door to greater thinking of ways to improve people’s lives. It does not come from thinking of a choice between covid-19 and “the economy.” The emphasis needs to be on people’s needs, especially those that come from relationships of mutual support, meaningful work and helping others.

Brian Martin
bmartin@uow.edu.au

Thanks to Lyn Carson and Richard Eckersley for helpful comments.

This post was published in Social Medicine and (in Spanish) in Medicina Social in vol. 13, no. 2, May-August 2020.

 

 

 

Vaccination debates: the corona connection

The coronavirus pandemic has intriguing connections with longstanding debates about vaccination.

Background

Vaccination proponents say it’s one of the most important public health measures of the past century, with its benefits in reducing infectious disease vastly outweighing any small risks. Critics say the benefits are overrated and that adverse effects are greater than normally acknowledged.

This was the state of play before the emergence of the new coronavirus, officially known as SARS-CoV-2. How does the coronavirus disease, Covid-19, affect the longstanding claims and counterclaims in the vaccination debate?

 

Quandaries for vaccination proponents

Covid-19 undermines one of the usual arguments for vaccination, namely that unless most people receive routine vaccinations, there is a possibility of a pandemic like the Spanish flu of 1918–1920 linked to the deaths of tens of millions of people. A moment’s reflection, though, should be enough to realise that vaccinating against polio and measles provides little or no protection against a new virus.

Vaccination proponents have tacitly admitted that, when a vaccine is not available, other measures may be necessary, notably contact tracing, quarantine and physical distancing along with hand-washing and other hygienic measures to reduce the risk of transmission. These are relevant for many vaccine-preventable diseases such as measles and whooping cough but are seldom emphasised, perhaps because they might detract from the importance, efficacy and efficiency of vaccination as the first line of defence.

Covid-19 has brought another possibility onto the agenda: the immunity to an infectious disease acquired by having it. This sort of acquired immunity was common before the advent of vaccines.

The entire population, referred to as the herd, is protected if enough people are immune. When, before the measles vaccine, most children had measles, this provided protection for those whose immune systems were impaired. If most people in a community have had Covid-19 then, assuming having had the disease confers immunity, the pandemic will end. However, this is likely to involve much illness and many deaths before herd immunity is attained.

            Critics of vaccines have argued that there are advantages to acquiring immunity by having a disease. Before Covid-19, this argument received very little public attention.

In the vaccination debate, proponents emphasise the importance of herd immunity. This is taken to be vaccine-induced herd immunity. That is, when most people are vaccinated and most gain immunity as a result, the disease agent dies out for lack of individuals to infect.

Some commentators (including scientists) have suggested that widespread immunity acquired from having Covid-19 is an endpoint worth considering. A possible option is to allow or even encourage young and healthy people to be infected while protecting older vulnerable individuals. Few governments have adopted this option, perhaps because it clashes with the vaccination paradigm.

In summary, Covid-19 has undercut the common assumption that vaccines are the only way of dealing with infectious diseases. Claims about unvaccinated children being a health threat, and their parents being irresponsible, have been superseded by worries about contagion from coronavirus-infected individuals.

Quandaries for vaccine critics

For critics of vaccination, Covid-19 raises a possibility that might not be welcome: that an effective vaccine, if developed, might be just what is needed to bring the pandemic under control or to limit its damage. Although all vaccines pose risks, if Covid-19 is as deadly as commonly believed, even a vaccine with significant adverse effects could have more benefits than harms. This is the same sort of assessment used with other vaccine-preventable diseases.

There has been much commentary about how long it will take to test a vaccine and roll it out for the world’s population. There is no guarantee that an effective vaccine can be developed. Just as importantly, vaccines pose risks, especially when introduced for emergency purposes. Mention has been made of the vaccine for the 1976 swine flu, a vaccine that caused more harm than the flu.

Vaccine critics are already warning about the potential dangers of a coronavirus vaccine, especially one that has not received sufficient testing. Some critics see a coronavirus vaccine as a stalking horse for the introduction of mandatory vaccination, including for other vaccines. The social control measures introduced for dealing with Covid-19 might be a precursor for a different control measure: enforced vaccination despite the risks.

Absent viewpoints

The public debate over vaccination is polarised: there are two sides with sharply divergent positions on benefits, risks, ethics and decision-making. This polarisation of the public debate occurs despite both sides having the same ultimate goal: protecting the health of the population, especially children. One of the effects of polarisation is to sideline other perspectives.

Proponents and critics of vaccination agree that immunity to disease is important but differ about the sorts of immunity they emphasise. Proponents focus on the benefits of vaccine-induced immunity whereas critics point to the benefits of natural  immunity.

The immune system can also be boosted through various means, including exercise, diet, vitamin D, sleep and mindfulness. (For references, see my book Vaccination Panic in Australia, pages 352-355.) One of the contradictory features of the response to Covid-19 is that control measures, especially quarantine, distancing and closure of businesses, may have negative effects on an individual’s immune system.

When gyms and pools are closed and exercise classes banned, people get less exercise. In principle, people can exercise by themselves at home, and indeed are encouraged to, but for many individuals the control measures will reduce their level of physical activity. Exercise has many health benefits aside from immune system improvement.

            How control measures are affecting diet is hard to determine. Closure of fast-food outlets might improve some people’s diets. On the other hand, staying at home and worrying can lead to less healthy eating.

            The body manufactures vitamin D when the skin is exposed to sunlight. Staying inside reduces vitamin D production.

Ample sleep benefits people’s immune systems and general health. Staying home more of the time may be enabling people to get more sleep, though worries and physical inactivity can impair sleep quantity and quality.

Mindfulness refers to a state of mind that is calm and focused; meditation is one way to be mindful. Worrying about Covid-19, and obsessively seeking information about risks, is contrary to mindfulness. So are losing one’s job and worrying about finances.

Research shows that personal relationships are crucially important to happiness. Distancing measures have disrupted many relationships, especially physical contact, and thus have adversely impacted wellbeing. There are also other adverse impacts, including increases in domestic violence.

            It is difficult to quantify the impacts of control measures on exercise, diet, vitamin D, sleep, mindfulness and relationships and hence difficult to take them into account in policy-making. Probably the impacts are more negative than positive.

One thing is certain: the vaccination debate will continue. Covid-19 may be causing some shifts in public discussions about immunity and vaccination but is incapable of ending the overall controversy.

Brian Martin
bmartin@uow.edu.au

Thanks to Tonya Agostini, Kevin Dew, Meryl Dorey, John Potterat, Jennifer Reich, Samantha Vanderslott and Jody Watts for valuable feedback on drafts. None of them necessarily agrees with any of the views in this post.

Virus debates

The arrival in 2019 of a novel coronavirus and its potentially deadly disease Covid-19 has led to an outpouring of commentary. The impacts on daily life have been enormous, hence it is natural for people to try to understand the significance of these events from their own perspectives.

For several decades, I’ve been studying public scientific controversies, such as the ones about nuclear power, pesticides and fluoridation. There are some regular, often predictable, features of longstanding controversies. Usually there are two sides, with one side supported by most scientific experts and one side backed by groups with wealth and power. For example, in the pesticide debate, most scientists support the pesticide approach to dealing with pests, and this approach is backed by the companies that manufacture the pesticides. This is the most common configuration: scientific experts align with powerful groups. Two exceptions are the debates over smoking and climate change. In each one, most experts are on one side while the most powerful corporate groups with a stake in the issue are on the other side.


It’s debatable: do masks work?

            From the point of view of controversy studies, what is most interesting about Covid-19 is the proliferation of contentious issues in a wide range of domains. Here I can do no more than list a few of these, without commenting on how they might pan out. Because the issues are changing so rapidly, I’m not giving links to sources; it’s easy to find them with a few keywords.

* Seriousness. Commentators differ about how serious Covid-19 is and will be. If most people eventually are infected and the mortality rate is one percent, the ultimate worldwide death toll will be huge. On the other hand, some suggest that the number of infections has been underestimated, so the mortality rate is much lower than one percent, perhaps not much different than for seasonal flu. Judgements about the seriousness of Covid-19 influence views about a number of the other disputed issues, including control measures and civil liberties.

* Control measures. Some experts and citizens have called for stronger isolation measures, or for them to be rolled out sooner. Others raise concerns about the adverse effects of the measures, especially in hurting the economy.

* Civil liberties. Some governments have introduced new measures to track individuals, for example to see whether infected individuals are maintaining their isolation. Concern has been raised about the curtailing of civil liberties, and that the surveillance powers might be used for other purposes or to continue after Covid-19 dangers have waned.

            * Economic equality. Measures against Covid-19 have caused immense economic disruption, including severe hardship in some sectors, for example the tourism industry and spectator sports. Many people have lost their jobs, and businesses have gone bankrupt. This has led to calls for introduction of a universal basic income (UBI), namely a subsistence payment to every member of the population. With a UBI, most other welfare measures could be eliminated. Some governments have introduced measures to protect some hard-hit individuals or sectors of the economy, but so far have not moved to introduce a UBI.

            * Equity. The benefits of control measures are primarily to those who would be seriously ill or die from Covid-19. Those most vulnerable are mainly older people with pre-existing health conditions, whereas the costs of control measures fall on a broad swathe of the population. Simplistically, this is a case of the young making sacrifices for the benefit of the old and infirm. Some might contrast this with intergenerational equity in the climate debate, in which climate sceptics, who tend to be older and richer, do not want to make sacrifices for future generations.

* Treatment. The standard medical methods for treating Covid-19 include drugs, oxygen and, if necessary, ventilators and other life-support technology. Various alternatives have been touted. There have been reports that Chinese doctors have been using intravenous vitamin C in large doses. This is considered “alternative” and shunned or condemned by mainstream figures. Similarly controversial is the use of homeopathic remedies in India.

            * Environmental factors. The standard medical approach is to treat each patient as needed, to promote vaccination (when vaccines are available) and, especially in the case of the coronavirus, to institute physical-distancing measures to slow the spread of the virus. In alternative health circles, there has been attention to the role of environmental factors in making individuals more susceptible to infection. Two factors have received the most attention: 5G and air pollution.

* Vaccination. Having a vaccine is widely assumed to be a way to end the pandemic. There are disagreements about how soon a vaccine can be ready and about whether it is even possible. Critics raise concerns about the hazards of vaccines, especially ones prepared in urgency and insufficiently tested.

* Trust. Governments and health authorities say it’s important that their rules and recommendations be followed. In other words, they say “Trust us.” Some commentators deplore those who question the authorities and warn people against misinformation. Trust in authorities has been declining for decades, and in the US there is a very low level of trust in governments and pharmaceutical companies. Many individuals examine a range of information and make their own judgements. The issue of trust might be considered a meta-level disagreement or divergence, as it underlies many of the other areas of dispute.

The value of public discussion

Some commentators say that government and health authorities need to speak in one voice, because disagreement undermines the effectiveness of measures implemented. On the other hand, there are benefits from disagreement and debate. In a situation of uncertainty, it can be valuable to hear a range of viewpoints, even ones that might seem ridiculous on the surface. Many members of the public have time on their hands, are stuck at home, and have an intense interest in an issue that has disrupted their lives and sometimes their livelihoods, not to mention risks to health. They are bound to explore information on the web, and to use their own judgement about what to believe. In this context, it is valuable for contentious issues to be openly discussed and for views to be presented and challenged with evidence and logic.

            In many controversies, partisans tout evidence supporting their own position and attack weak points in the opponent’s position. This can rally supporters but is not convincing to opponents. A more rigorous approach is to spell out the strong points in the opponent’s position, ideally to the opponent’s satisfaction, and address them systematically. For example, it is easy to dismiss concerns that 5G is part of a plot to harm people but more rigorous to address arguments that 5G might have some impact, maybe small, on people’s immune systems. (I use this example because I haven’t examined any of the claims about 5G!)

Some people will be receptive to sensible comments. There should be no fear of dissent and debate, as long as participants engage with each other openly and respectfully.

Brian Martin
bmartin@uow.edu.au

Ageing: how to do it better

“If I had known I was going to live so long, I’d have taken better care of myself.”

There is an important truth in this saying. People in many countries are living longer than ever before. Surviving into your 80s, 90s and beyond is no longer unusual. However, quality of life in later years is not always the best due to dementia, disability, pain or loneliness. What can you do to ensure that your life is healthy for as long as possible?

            For the most comprehensive and up-to-date treatment available, turn to Daniel Levitin’s book Successful Aging, just published. Levitin is a neuroscientist who has written a number of books for general audiences. For Successful Aging, he said he examined more than 4000 scientific papers, many of which are listed in the back of the book. The main text, though, is free of academic apparatus. Levitin interviewed many individuals, including prominent ones like the Dalai Lama. His book is filled with anecdotes, quotes and stories as well as descriptions of research findings.

            Did you ever want to know how the brain operates? Consider your memory, something many older people worry about. Why does it seem to be getting worse? Levitin delves into the details of acquiring, storing and retrieving memories, telling about how there are different memory systems distributed across the brain. Did you know you can learn things better after exercising or that a chronic shortage of sleep can undermine acquisition of memories?

            Levitin tells about how many of the body’s systems degrade with age. Muscles become weaker, nerves respond less quickly and the mind is less receptive to new experiences. It sounds all downhill, but Levitin repeatedly emphasises the positives of being older.

As our senses acquire more experience, our minds become better at interpreting fuzzy sensations. The mind becomes more efficient at filling in incomplete perceptions, which means less effort and energy are required. So in some ways, perceptual capacities improve.

Older people, with their life experience in doing different things, have learned which ones give them satisfaction, and spend more time doing them. Older people, Levitin says, are less likely to dwell on negatives, instead focusing on positives. The result is that, according to surveys, people are happiest in the 80s, despite physical frailty and health problems. However, this is an average result: some oldies are unhappy while others flourish. Even so, for anyone younger, this is hope for the future.

Exercise and diet

Levitin emphasises several things that are especially important for ageing well. One of them is physical activity. Through various processes, it improves both physical and mental health. The biggest impacts come from modest amounts of activity when compared to none; successive increments of additional activity are beneficial but with declining marginal utility.

            Older people, at least those with aches and pains or with serious health conditions, may feel like they need to take it easy, but the evidence is that activity is beneficial to all. Levitin, giving special attention to mental functioning, recommends activity that requires mental alertness. He cites trekking on new paths, noting that the process of identifying the best spot to next put your foot stimulates the mind. Other options that do this include orienteering and competitive sports. On the other hand, using an exercise bike has more limited demands on the brain.

Another important contribution to healthy old age is an appropriate diet. Levitin canvasses a range of evidence about various options, for example the Mediterranean diet and the paleo diet. He concludes that the most important thing is to avoid processed foods and deep-fried foods. Aside from this, he says, it doesn’t seem to matter all that much what you eat.

Then there’s the question of how much to eat. Experiments with rats show that reducing the number of calories (or kilojoules) consumed leads to increases in longevity, but the evidence about this for humans is less than solid. Levitin notes that some researchers in this field have adopted occasional interruptions to normal eating patterns, skipping meals or fasting one day per week.

            Levitin is sceptical of the value of vitamin and mineral supplements, saying there is little evidence they significantly improve health. However, he is all in favour of vitamins and minerals ingested via a varied diet. More generally, he is sceptical of alternative medicine. He doesn’t mention that many in the alternative health area recommend fasting as a health practice.

Sleep and work

As a neuroscientist, Levitin gives plenty of attention to sleep because of its importance to functioning of the brain. Sleep enables consolidation of memories. It is also probably helpful in reducing the risk of dementia. Yet many people spend much of their lives in a sleep-deprived state. Levitin explains why. Prior to widespread artificial lighting, most people slept according to the cycle of day and night. Now, with electric lights, natural cycles are interrupted, and light from mobile devices extends the interruption.

            Most people use drugs to maintain alertness while awake — think coffee, tea, soft drinks and energy drinks — and sometimes to fall asleep. Levitin provides information on the down sides of this cycle, recommending a lifestyle that is closer to pre-industrial, for example avoiding blue lights (from screens) in the time before bed. There is also a cultural challenge: getting plenty of sleep is seen as an indulgence inappropriate for those trying to impress their colleagues about their commitment to work.

Re work, Levitin makes a strong recommendation: “Never retire.” He doesn’t mean to keep working at a job you hate. He means keep doing whatever provides challenge and a purpose in life. There’s no particular challenge in watching television or sitting beside the pool sipping a martini.

It is common to distinguish between work and leisure, and to see leisure as better. However, for quality of life, working at things you care about is important. Work provides a mental challenge. Also, interacting with people is good for the brain. Levitin recommends spending time with younger people, children and adults, as a way of maintaining mental openness to experience. Oldies have a harder time learning new things, so the pressure of interacting with youngsters is valuable in preventing getting stuck in mental routines.


Daniel Levitin

            What about doing puzzles such as sudoku and keeping mentally active through electronic brain training exercises? Levitin says these are fine but there’s no evidence that they prevent dementia. Doing sudoku helps you get better at sudoku but doesn’t seem to have any general benefit for mental functioning. That’s true of most activities: they help you do better at specific tasks. So for overall brain health, activities that stimulate the mind in varied and varying ways, including unpredictable ones, are the most beneficial.

People

Being lonely is bad for you: bad for you both physically and mentally. An important part of ageing well is maintaining social connections. This requires effort. As you get into your 70s and 80s and beyond, many of your long-time friends and contemporary family members are likely to die, so effort is required to build new personal connections, and this sort of effort tends to be greater for older people. For those with children and grandchildren, contact with a younger generation may be readily available, assuming they are nearby. Otherwise, though, it is important to try new activities, ones that are stimulating socially, mentally and physically.

Beyond individualism

Levitin’s advice is based on the latest scientific studies of ageing, nutrition, exercise, sleep and social interaction. His approach is most suited for affluent people. One thing is missing: social change. Levitin describes what you can do as an individual, assuming society is fixed. His recommendations could be turned around to become prescriptions for how society might be organised to support successful ageing.

Sleep, for example, has become more difficult because of the 24-hour economy and the proliferation of digital devices. Those who feel obliged to work the night shift pay a penalty in terms of their sleep and hence their health. Digital addictions, fostered by companies who profit from them, are also hindering sleep.

Similarly, societies organised around the car and labour-saving devices make it more difficult to get adequate exercise, and societies organised around the nuclear family make it more difficult to have everyday interactions with younger people.

It is fascinating to imagine a society organised to maximise brain rejuvenation. It would facilitate working at advanced ages, build physical activity into doing everyday things like shopping and commuting, and foster intergenerational interactions. The title of Levitin’s book, Successful Aging, might become Social Change for Ageing. Don’t expect this to happen quickly, or even in your lifetime. But promoting this sort of social change could provide a purpose in life, a purpose valuable for you and many others.

Brian Martin
bmartin@uow.edu.au

Postscript: a few quotes from Old age ain’t no place for sissies

“Age is a question of mind over matter. If you don’t mind, it doesn’t matter. – Satchel Paige

“Old age is like climbing a mountain. You climb from ledge to ledge. The higher you get, the more tired and breathless you become, but your views become more extensive.” – Ingrid Bergman

“Old age isn’t so bad when you consider the alternative.” – Maurice Chevalier

“The secret of staying young is to live honestly, eat slowly, and lie about your age.” – Lucille Ball

“Surely the consolation of old age is finding out how few things are worth worrying over” – Dorothy Dix

How old is old? Kids answer.

“I can’t imagine living past 45 or so. I think I’ll be so bored by then.” – Jenna, age 12

“No one is ever old until they’re dead.” – Leroy, age 11

The glyphosate chronicles

Glyphosate is the world’s most widely used herbicide. Is it as safe as its manufacturer claims?

Glyphosate is the principal ingredient in the herbicide named Roundup. It seems miraculous. It is deadly to weeds, yet harmless to humans, or so says Monsanto, the massive chemical company that manufactures it. (In 2018, Monsanto was purchased by Bayer.)

Glyphosate is used on crops such as soybeans, corn and canola. It is used by local governments to control weeds in public areas. It is used on golf courses. It is used by householders to maintain beautiful lawns.

The biggest use is on crops. Glyphosate is deadly to all growing things, so initially Roundup had to be applied to the weeds but not the crops. However, when the patent on Roundup was about to expire, Monsanto developed a brilliant way to maintain sales. Using genetic engineering techniques, it spliced a gene into crops, such as soybeans, that made them resistant to glyphosate. As a result, Roundup could be sprayed directly on the crops. Weeds would be killed, but genetically modified crops would not be harmed. Such crops are called Roundup Ready.

What happened when farmers started reporting disease and scientists started finding problems? If you want the inside story, get Carey Gillam’s book Whitewash: the story of a weed killer, cancer, and the corruption of science. Gillam is an experienced journalist who was put on the agriculture beat and began looking behind the scenes. The picture isn’t pretty. She is now research director at U.S. Right to Know.

The victims and the regulators

Monsanto claimed that Roundup was safe, so safe that you could probably drink it without harm. But what about farmers who had used Roundup for decades and then developed non-Hodgkin’s lymphoma? There seemed to be a pattern, especially given experiments with mice.

What about government regulators? The US Environmental Protection Authority (EPA) is supposed to be protecting the health of both people and the environment. Yet the EPA has seemed to be in the pocket of Monsanto, in all sorts of ways.

The EPA can set upper limits to the intake of chemicals. However, when it came to glyphosate, the limits it set were high, and were increased in line with increased use of the herbicide. This was despite the applications of glyphosate becoming ten times as great over a period of two decades.

You might expect that with glyphosate being the most heavily used herbicide in the world, there would be numerous studies of its prevalence and its impacts. Quite the contrary. For years, no figures were collected of the levels of glyphosate in different crops. The reason: because it was presumed to be safe, there was no need to see what levels were appearing in foods. For years, studies were not carried out on glyphosate’s possible health hazards. Again, the rationale was that it was so safe that there was no need for testing.

Much that Gillam reports relies on documents obtained using the discovery process in court cases, in which parties are required to provide relevant documents to the other side. Monsanto’s activities in subverting scientific research have been remarkable.

Monsanto cultivated allies within the EPA and used them to block introduction of regulations. It cultivated tame scientists who would go on the attack against anyone who criticised glyphosate. These tame scientists were given “talking points” so they would know what to say, and given guidance on venues for giving talks and submitting articles. These tame scientists did not reveal their links to Monsanto. In this way, Monsanto could get out its message via seemingly independent scientists.

Resistance – by pests

According to its promoters and defenders, glyphosate is a miracle chemical, so safe to humans that it can be used widely with little or no impact on human health. However, it is not pure glyphosate that is applied to crops, gardens and walkways, but Roundup, which contains additional chemicals, including one called polyethoxylated tallow amine or POEA. The combination of glyphosate and POEA is what needs to be tested, but this is hardly ever done.

However safe Roundup might be, there’s another problem. Pests can develop resistance to it. This is evolution in action: a few pest species have or acquire resistance to the pesticide, so they are the ones that start growing and spreading.

Because Roundup has been so remarkably effective in eliminating pests, farmers have become complacent. Instead of rotating crops – a traditional practice that reduces pest problems and replenishes the soil – farmers have planted the same crops year after year, relying on Roundup rather than other methods to keep pests at bay.

When Roundup-resistant pests started appearing, what was the solution? Farmers turned to other pesticides, using them in addition to Roundup. Some of these other pesticides are more highly toxic. This is the pesticide treadmill, in which the only solution to pests, even when they become resistant, is more pesticides.

Pesticide treadmill

Some farmers had nearly forgotten how to grow crops in traditional ways. Others, though, have turned towards alternatives, including organic agriculture.

History repeats

Is Gillam’s treatment of the glyphosate saga accurate? Her account rings true, because it is history repeating. Monsanto’s response to criticisms of Roundup is remarkably similar to the response by earlier pesticide manufacturers to criticisms.

Rachel Carson

Rachel Carson’s famous book Silent Spring, published in 1962, raised the alarm about the effect of pesticides on wildlife and, tentatively, on human health. Many people have heard of Silent Spring, which is often credited with inspiring the modern environmental movement. Less well known is that Carson and Silent Spring came under fierce attack by chemical corporations. This is documented in a revealing 1970 book by Frank Graham, Jr., titled Since Silent Spring.

In 1978, biologist Robert van den Bosch’s book The Pesticide Conspiracy appeared. Van den Bosch told about the strong-arm tactics of the pesticide manufacturers, recounting case after case of scientists whose research and careers were attacked after they reported findings critical of pesticides.

Gillam’s story of Monsanto’s tactics to attack any threat to its highly profitable Roundup is eerily similar to the tactics used by pesticide companies since the 1960s. It seems little has changed since, decades ago, I investigated suppression of scientists who questioned pesticides. Given that the tactics are predictable, it is plausible to work backwards and assume that presence of these tactics indicates the likelihood of shortcomings in the pesticide paradigm. So what are the tell-tale tactics?

* Attacks on scientists who report research results showing dangers or limitations of pesticides.

* Regulatory agency dependence on industry testing of pesticides.

* Testing only of the active ingredient, not of the pesticide actually used.

* Corporate ghostwriting of research papers.

* The failure of companies to release documents except through freedom-of-information requests or court discovery processes.

* A revolving door between company jobs and jobs in the corporate regulator.

* Presence on expert panels of members with conflicts of interest.

* Failure to carry out relevant research or collect relevant data, such as amounts and locations of pesticides used.

The presence of these tell-tale signs does not prove that a pesticide, or some other product or practice, is dangerous, but it does point to areas where extra scrutiny is warranted.

If you start investigating the likelihood that corporations and regulators are not serving the public interest, be prepared to be ignored or, if you start having an impact, being the target of dirty tactics.

Carey Gillam

“Monsanto Company and many leading chemical industry experts tell us that we should trust them and that more research is not needed. The safety of glyphosate and Roundup is proven, they say. But trust is hard to come by when the government does not require robust long-term safety data for a finished product such as Roundup, only for the active ingredient. There have long been concerns that the end product is more dangerous than glyphosate alone, and scientists say it is well-known that extra ingredients in pesticide products not only may themselves be toxic but also may enhance or supplement the toxic effects of the active ingredient. Extra ingredients in pesticides commonly include surfactants that help chemicals stick to the leaves of plants, antifoam compounds, and more. Yet the bulk of industry-sponsored toxicology tests are done using only the active ingredient. As well, there is very little long-term epidemiology data on glyphosate exposure, and there is no established base of information about just how much of the pesticide is in the products we eat and drink because the U.S. Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA) have so steadfastly avoided including glyphosate in their testing regimes. And despite industry assurances of safety, there is an international body of published research that contradicts those claims.” (pp. 79-80)

Brian Martin
bmartin@uow.edu.au

An HIV mystery in Africa

According to mainstream scientists, HIV transmission in Africa operates differently than elsewhere. An alternative view has been systematically ignored and silenced.


HIV prevalence in Africa

AIDS is the most deadly new disease in humans, with the estimated death toll exceeding 30 million. In order to restrain the spread of the infective agent HIV, scientists have tried to figure out how it spreads. The consensus is that HIV is most contagious via blood-to-blood exposures, such as through shared injecting needles, and in comparison the risks of transmission via heterosexual sex and childbirth are small.

However, there’s a mystery in relation to Africa. The scientific consensus is that in Africa, unlike elsewhere, HIV spreads mainly through heterosexual sex. Why should this be?

John Potterat is a public health researcher who spent decades tracking the spread sexually transmitted diseases in the US. He became interested in the African mystery and developed an alternative hypothesis. He and colleagues wrote many scientific papers about it, but were rebuffed by mainstream scientists. Here I will tell about Potterat’s experience drawing primarily on his engagingly written book Seeking the positives: a life spent on the cutting edge of public health, in particular the chapter “Why Africa? The puzzle of intense HIV transmission in heterosexuals”.

Some background

My own interest in research on AIDS derives from a different controversy, the one over the origin of AIDS. The standard view is that AIDS first appeared in Africa and was due to a chimpanzee virus, called a simian immunodeficiency virus or SIV, that got into a human, where it was called a human immunodeficiency virus or HIV. Chimps have quite a few SIVs, but these don’t hurt them presumably because they have been around long enough for the population to adapt to them, in the usual evolutionary manner. There are various species of chimps, and when a chimp is exposed to an unfamiliar SIV, it can develop AIDS-like symptoms.

            So the question is, how did a chimp SIV enter the human species and become transmissible? The orthodox view is that this occurred when a hunter was butchering a chimp and got chimp blood in a cut, or perhaps when a human was bitten by a chimp, or perhaps through rituals in which participants injected chimp blood.

In 1990, I began corresponding with an independent scholar named Louis Pascal who had written papers arguing that transmissible HIV could have entered humans through a polio vaccination campaign in what is present-day Congo, in which nearly a million people were given a live-virus polio vaccine that had been grown on monkey kidneys. The campaign’s time, 1957 to 1960, and location, central Africa, coincided with the earliest known HIV-positive blood samples and the earliest known AIDS cases.

            Despite the plausibility and importance of Pascal’s ideas, no journal would publish his articles, so I arranged for his major article to be published in a working-paper series at the University of Wollongong. Independently of this, the polio-vaccine theory became big news. Later, writer Edward Hooper carried out exhaustive investigations, collected much new evidence and wrote a mammoth book, The River, that put the theory on the scientific agenda. Over the years, I wrote quite a few articles about the theory, not to endorse it but to argue that it deserved attention and that scientific and medical researchers were treating it unfairly.

In the course of this lengthy controversy — which is not over — I became increasingly familiar with the techniques used by mainstream scientists to discredit a rival, unwelcome alternative view. I had been studying this, on and off, since the early 1980s; the origin-of-AIDS saga made me even more attuned to how dissenting ideas and researchers can be discredited.

With this background, when I read John Potterat’s chapter “Why Africa?” it was like he was providing a front-row seat for a tutorial on how an unwelcome view can be marginalised. I saw one familiar technique after another.

I’m not here to say that Potterat’s view is correct. Furthermore, unlike the origin-of-AIDS debate, I haven’t studied writings about HIV transmission in Africa. What I do here is outline Potterat’s account of his experiences and comment on the techniques used to dismiss or discredit the ideas he and his collaborators presented to the scientific community.


John Potterat

Contact tracing

HIV is infectious, so it is important to know exactly how it gets from one person to another. Knowing transmission routes is the basis for developing policies and advice to prevent the spread of the virus.

In Seeking the Positives, Potterat tells about his personal journey in scientific work. It was unusual. With a degree in medieval history, he ended up with a job in Colorado Springs (a moderate-sized town in Colorado) tracking down networks of people with sexually transmitted diseases (STDs). Learning from his mentors, the approach he developed and pursued with vigour was to interview infected individuals, find out their sexual or injecting-drug partners and proceed to build up a database revealing the interactions that spread the disease. The military base near the city meant there were lots of prostitutes (some permanent, some seasonal) and STDs to track. This sort of shoe-leather investigation (seeking those positive for disease) led to many insights reflected in a vigorous publication programme. For the Colorado Springs research team, AIDS became a key focus from the 1980s on.

When submitting a paper to a scientific journal, editors and reviewers are supposed to assess it on its merits. It should not matter whether an author has a PhD in epidemiology from Oxford or no degree at all. The test is the quality of the paper. Potterat became the author of dozens of scientific papers. However, his unusual background may have been held against him in certain circles.

In Seeking the Positives, Potterat doesn’t tell that much about his team’s clients/informants. Sensitively interviewing prostitutes, partners of prostitutes, drug users, gay men and others would have been a fascinating topic in itself, but Potterat focuses on the research side of the story.


A diagram from one of Potterat’s papers

            You might think that contact tracing is an obvious way to study the transmission of disease, especially a new disease for which the patterns of contagion are not fully understood. But what Potterat’s team was doing was unusual: mainstream AIDS researchers pursued other approaches. Because the mainstream researchers had lots of research money, they didn’t take kindly to a small, non-prestigious team doing something different.

Mainstream groups, both researchers and activists, raised a series of objections to HIV contact tracing. First they said there was no reason for contact tracing unless there was a test for HIV. Second, after a test became available in 1985, they said tracing would allow the government to compile lists of homosexuals. Third, they said that without effective treatment, notifying individuals would distress them and lead to suicides. Fourth, after the drug AZT became available in 1987, they said contact tracing would be too expensive.

            The interesting thing here is that none of the objections was backed by any evidence. Potterat says that in his team’s studies nearly all of those approached for contact tracing were very helpful.

“Contact tracing was generally opposed by AIDS activists, by civil libertarians, and (disappointingly) by many public health workers, who were often influenced by political correctness and by not wanting to offend strident constituencies.” (pp. 68-69)

Later, mainstream public health officials in the US took the line that AIDS was a danger to the heterosexual population, not just to gays and injecting drug users. If HIV was highly contagious in the wider population, this lowered the stigma attached to gays and injecting drug users, and coincidentally made it possible to attract more funding to counter the disease, a worthy objective. However, contact tracing showed that HIV transmission was far higher in specific populations. This was another reason the research by Potterat’s group, published in mainstream journals, didn’t lead to changes in research priorities more generally.

HIV transmission in Africa

In 2000, Potterat was approached by David Gisselquist about the spread of AIDS in Africa, questioning the usual explanations for why the mechanisms were claimed to be different from those in Western countries. After his retirement the following year, Potterat and some of his collaborators joined with Gisselquist in examining the studies that had been made.


David Gisselquist

            The orthodox view was that in Africa, uniquely, HIV transmission occurs primarily through heterosexual sexual activity. This, according to Potterat et al., was based on assumptions about high frequencies of sexual interactions and high numbers of partners, neither of which were supported by evidence. They said the evidence suggested that sexual activity in Africa was much like elsewhere in the world.

In this was the case, the orthodox view couldn’t explain HIV transmission in Africa, so what could? The answer, according to Potterat and his collaborators, was skin-puncture transmission that occurred when contaminated needles were reused during health-care interventions such as blood testing, vaccinations and dental work, plus tattooing and traditional medical practices. This was heresy. It was also important for public health. Potterat writes, “Only when people have accurate knowledge of HIV modes of transmission can they make good decisions to protect themselves and their families from inadvertent infection.” (p. 200)

Potterat’s team wrote dozens of papers, but they had a hard time getting them published in top journals, where orthodoxy had its strongest grip. Nevertheless, they were quite successful in publishing in reputable journals of slightly lower standing.

Responses

The most common response was to ignore their work. Even though Potterat et al. had poked large holes in the orthodox view, orthodoxy was safe if the critique was given no attention.

Another response was to try to prevent publication of orthodoxy-challenging research. One study was by a team, not Potterat’s, involving Janet St. Lawrence, then at the Centers for Disease Control and Prevention (CDC), and her colleagues. According to Potterat, St. Lawrence’s CDC superiors asked her not to publish the paper, but she refused. The paper was rejected by several journals, and then submitted to the International Journal of STD & AIDS. After peer review and acceptance, the CDC applied pressure on the editor to withdraw acceptance, but he refused. This is just one example of efforts made to block publication of dissenting research findings.


Janet St. Lawrence

“… it does not engender trust in the official view to know that our informal group has solid evidence of several instances by international health agencies actively working to suppress findings supportive of non-sexual transmission and to discourage research into non-sexual transmission.” (p. 221)

Another tactic was to misrepresent views. On 14 March 2003, the World Health Organisation held a meeting of experts to, as stated in a memo to participants, “bring together the leading epidemiological and modeling experts with Gisselquist and Potterat.” Potterat was dismayed by the consultation: data disagreeing with the orthodox view was dismissed. After the meeting, a statement was put out by WHO presented as representing a consensus. Actually, this so-called consensus statement did not represent everyone’s viewpoints, and was actually finalised prior to the conclusion of the meeting. (This was an exact parallel to what happened at an origin-of-AIDS conference.)

Potterat was surprised and disappointed to be subject to ad hominem comments, otherwise known as verbal abuse. He writes:

“Among other, less printable, things I was called ‘Africa’s Newest Plague’; ‘Core Stigmatizer’; ‘Linus Pauling—in his later years’ (when Pauling was thought to be advancing crackpot ideas); and [a reward being offered] ‘for his head on a platter’.” (pp. 193-194)

Potterat was surprised at this invective because none of his team had imagined the resistance and anger their work would trigger among mainstream agencies and researchers. He was disappointed because many of the comments came from colleagues he had previously admired.

Undone science

Researchers into the dynamics of science have coined the term “undone science” to refer to research that could be done and that people are asking to be done, but nevertheless is not carried out. A common reason is that the findings might turn out to be unwelcome to powerful groups. Governments and industry, through their control over most research funding, can stifle a potential challenge to orthodoxy by refusing to do or fund relevant research.

            Undone science is most common in areas where citizen groups are calling out for investigations, for example on the environmental effects of mining in a particular area or the health effects of a new chemical. Three research students who I supervised used the idea of undone science as a key framework for their theses, on drugs for macular degeneration, on vaccination policy, and on the cause of the cancer afflicting Tasmanian devils. My former PhD student Jody Warren and I, drawing on our previous work, wrote a paper pointing to undone science in relation to three new diseases. With this experience, I was attuned to notice cases of undone science in whatever I read. In Potterat’s chapter “Why Africa?” there were many striking examples.

In their papers, Potterat and his colleagues presented findings but, as is usual in scientific papers, acknowledged shortcomings. In one case, to counter criticisms, they reviewed research on the efficiency of HIV transmission by skin-puncturing routes, while admitting that new studies were needed to obtain better data. Potterat concludes, “To my knowledge, such studies have not been fielded.” (p. 199)

In another study, on discrepancies in studies of Hepatitis-C strains and patterns, Potterat writes, “In the intervening decade, however, no studies had been fielded to resolve these uncertainties.” (p. 199)

Potterat and his collaborators were unable to obtain external funding to carry out studies to test their hypotheses. So Potterat used his own money for a small study of HIV transmission in Africa. “Yet this pilot study supported our contentions and should have provoked the conducting of larger studies to confirm our findings. Regrettably, this did not happen.” (p. 205)

Similar responses

As stated earlier, I am not in a position to judge research about transmission of HIV in Africa. I approach the issue through Potterat’s account of the tactics used by supporters of orthodoxy against a contrary perspective. The tactics, according to him, included ignoring contrary findings, denigrating the researchers who presented them, putting out a misleading consensus statement, and refusing to fund research to investigate apparent discrepancies. I was struck by the remarkable similarity of these tactics to those used against other challenges to scientific and public-health orthodoxy. This does not prove that the dissident viewpoint is correct but is strong evidence that it has not been treated fairly. To be treated fairly is usually all that dissident scientists ask for. The hostile treatment and failure to undertake research (“undone science”) suggest that defenders of orthodoxy are, at some level, afraid the challengers might be right.

Potterat nicely summarises the multiple reasons why the findings by him and his colleagues were resisted.

“By their own admission, the international agencies feared that our work would cause Africans to lose trust in modern health care, especially childhood immunizations, as well as undermine safer sex initiatives. (Recall that their condom campaigns were also aimed at curtailing rapid population growth in sub-Saharan Africa.) We speculate that disbelief on the part of HIV researchers that medical care in Africa could be harming patients may have been a significant factor in their defensive posture. We were also impugning the quality of their scientific research and potentially threatening their livelihoods. In addition, our analyses also directly threatened the politically correct view that AIDS was not just a disease of gay men and injecting drug users, but also of heterosexuals. Lastly, our data were undermining the time-honored belief about African promiscuity, a notion that may well have initially contributed to the (pre)conception that AIDS was thriving in Africa because of it.” (p. 194)

The depressing lesson from this saga, and from the many others like it, is that science can be subject to the same sorts of groupthink, intolerance of dissent, and defence of privilege that afflict other domains such as politics. To get to the bottom of long-standing scientific disputes by trying to understand the research is bound to be time-consuming and very difficult, something few people have the time or interest to pursue. I aim at something easier: observation of the tactics used in the dispute. This doesn’t enable me to determine which side is right but does give a strong indication of whether the dispute is being pursued fairly.

Brian Martin
bmartin@uow.edu.au

Thanks to Al Klovdahl for valuable suggestions.

Obtain free downloads of John Potterat’s chapter “Why Africa?” or the entire book Seeking the Positives

Addicted to the screen?

Behavioural addictions are on the rise. It’s important to understand and be able to change them.

It’s commonplace to see people walking along with their eyes focused on their smartphones. Surveys show that many check their phones the last thing before going to sleep and the first thing when they wake up. And they have them within arm’s reach the whole night.

Some online gamers refuse to take a break, playing for days and nights on end. Playing the game becomes more important than eating or sleeping.

Is it reasonable to refer to obsessions of this sort as addictions? If so, they are addictions to behaviours, not substances.

            For insight into this rising problem, check out Adam Alter’s new book Irresistible. The subtitle explains the topic: Why we can’t stop checking, scrolling, clicking and watching. The book is highly readable, though not quite as irresistible as the activities Alter describes.

            To provide a context for understanding behavioural addictions, Alter examines the more familiar sort of addiction, to drugs. The usual idea is that the physical processes involved are the key, including wanting the drug and having withdrawal symptoms. In relation to pain medication, Alter says something more is involved: a psychological component, in particular emotional pain. Alter says addiction “isn’t the body falling in unrequited love with a dangerous drug, but rather the mind learning to associate any substance or behavior with relief from psychological pain.” (p. 89) For example, people who were sexually abused as children may cover up the emotional pain by using drugs.

So what’s involved?

“Behavioral addiction consists of six ingredients: compelling goals that are just beyond reach; irresistible and unpredictable positive feedback; a sense of incremental progress and improvement; tasks that become slowly more difficult over time; unresolved tensions that demand resolution; and strong social connections.” (p. 9)

Alter devotes a chapter to each of these six ingredients. One of the fascinating insights is the way designers try to make activities enticing.

Consider poker machines, in which players put in their money in the hope of winning a prize, especially a jackpot. Research shows that near misses provide an incentive to keep playing. Even so, there are fallow periods with no wins during which players are inclined to quit. In the US, gambling establishments are prohibited from manipulating the odds. So instead of the machine giving a little payout just when a player was thinking of quitting, an employee, watching the proceedings, will provide a small gift, such as chocolates. Even this process can be automated, with the machine providing information to the proprietors as to when to offer a gift to a player.

            Gambling addictions involve unpredictable positive feedback, but there is not incremental progress and improvement. For greater behavioural addiction, skill is involved, and skills improve.

Video games are the most common type of behavioural addiction. The most engaging games are very easy to learn, provide pathways for gradual improvement but make it impossible to achieve total mastery: there is always another level of difficulty. Alter interviewed video game designers. Some of them became addicted to their own games, and so did everyone else around them.

            Television producers try to induce viewers to keep watching a serial by using the technique of “unresolved tensions that demand resolution”, more commonly called cliffhangers. Near the end of an episode, some new development – an unexpected phone call, illness or assault – will be provided so viewers will want to tune in to the following episode to find out what happened next, namely to resolve the tension. This technique helps explain the popularity of soap operas and quite a few TV series. However, watching a show once a week is not a big problem. The addictive qualities of cliffhangers become more obvious when entire series are available on demand. Some viewers watch two or more episodes at once, or even binge for several days.

Knowing about the cliffhanger technique, a bit of planning can overcome bingeing on multiple episodes. The key is to end the viewing session after resolution of the tension, maybe 5 or 10 minutes into the next episode, and then start there the next time.

Alter provides numerous tips for overcoming or avoiding addictive behaviours. Email is a common problem: as soon as there’s a notification of an incoming message, it has to be checked or willpower is needed to resist checking it. One solution is to disable notifications. An even stronger technique is to shut down email altogether for most of the day, only opening it for a limited time. Alter counsels against the aspiration of an empty inbox, because this goal encourages obsessive checking of emails.

It’s now possible to buy all sorts of monitors, for example to record your pulse and the number of steps you’ve taken. Setting goals is fine, but Alter warns about making them too precise. When setting yourself the goal of 12,000 steps in a day, there’s a risk of injury by over-exercising. The target goal can overshadow messages from the body about exhaustion or pain. Self-monitoring runs the risk of encouraging addiction.

Who is susceptible?

It used to be thought that drug addicts had weak personalities and that to break an addiction, all that is needed is the assertion of willpower. These views are thrown into question by evidence that the environment makes a huge difference in addictions. Alter refers to the heroin users among US troops in Vietnam during the war. On returning to their home communities in the US, very few maintained their habits. The implication is that changing an addict’s environment is central to change. This includes being around different people and avoiding the triggers for the habit.

With behavioural addictions, environments are changing in ways that make more people susceptible. Video game addiction occurred from the earliest days of gaming. It was often thought that young males were especially vulnerable. But the reason they were more commonly addicted was opportunity. Not having jobs or other responsibilities, and having access to game consoles, they could devote hours to gaming every day.

            Therapists who treat gaming addicts have noticed an explosion in addiction in the US since the arrival of the iPhone in 2007 and the iPad in 2010. Suddenly many more women and older men began developing addictions. The reason: access to games has gone mobile. No longer anchored to a console, you carry your device with you. It’s like having drugs on demand, with no cost.

For substance addictions, one treatment option is abstinence. It’s possible to totally avoid alcohol or heroin, and this is the basis of twelve-step programmes, most famously Alcoholics Anonymous. However, treating Internet addictions through abstinence is not feasible, because jobs and other activities so commonly involve operating online. Alter canvasses various ways to deal with Internet addiction. Many of these draw on insights about how to change habits.

The difficulty of changing habits points to a strange discrepancy. Powerful groups seek to promote behaviours, like checking Facebook, that serve their interests, but that can become addictive. There are relatively few groups dedicated to countering these potentially addictive behaviours. Furthermore, there is even less effort put into helping people break damaging habits.

It’s worth thinking broadly about damaging habits and challenges to them. Smoking is the classic example. Tobacco companies benefited from hooking people on smoking and it has taken extraordinary efforts by campaigners to bring tobacco addictions under control. A key part of the change has been to make ever more spaces non-smoking. Another part has been to stigmatise smoking.

Alcoholism remains a scourge on many people’s lives. Alcohol producers so far seem to have avoided many of the controls applied to smoking.

Then there are illegal drugs such as marijuana, heroin and ice. The prohibitionist impulse is a manifest failure, enabling the rise of organised crime with disastrous consequences for users and their families.

With the vast expansion of behavioural addictions, what are the choices? Internet companies benefit from behaviours, like checking phones regularly, that easily become addictive. Because there is relatively little harm to others, there is unlikely to be a movement analogous to the anti-smoking movement. So what are the prospects?

            One source of hope is the availability of apps and devices to control Internet use, for example apps to shut down access after a specified time. But even to use such apps requires a degree of self-awareness. Ultimately, the culture of Internet use needs to change. If checking a phone while talking face-to-face with a friend were seen as extremely discourteous, there is some hope, but only if talking face-to-face remains common. Perhaps things will have to become much worse before major efforts are made to change social expectations.

Imagine that all children learn, at home and in school, the characteristics of addictive behaviour and how to change habits. Imagine people becoming more self-aware of their own damaging or time-wasting habits. Imagine companies becoming more responsible. If you’ve come this far, you have a good imagination and maybe you’re just dreaming.


Adam Alter

Brian Martin
bmartin@uow.edu.au